Clinical research studyPost-myocardial infarction smoking cessation counseling: Associations with immediate and late mortality in older Medicare patients
Section snippets
Study sample and design
The CCP, a national quality improvement project funded by the Centers for Medicare and Medicaid Services (CMS), included reviews of medical records from a random sample of 234 754 Medicare patients hospitalized with myocardial infarction at 6684 hospitals in 1994 and 1995.20, 21, 22 Acute myocardial infarction cases with an International Classification of Diseases, 9th Revision, Clinical Modification 27, principal discharge diagnosis code of 410 were identified using the Medicare National Claims
Results
Of the 16 743 smokers, 41% had medical record documentation of counseling to quit smoking during their admission. Whites were more frequently counseled than African-Americans (42% vs. 34%, P ≪0.0001) (Table 1). Older patients were less frequently counseled. Surprisingly, patients with diabetes or chronic heart failure were slightly less frequently counseled and increasing severity of illness (APACHE II) was associated with lower rates of counseling.
Discussion
In our large national dataset, smokers hospitalized with acute myocardial infarction who had inpatient medical record documentation of advice to quit smoking had lower 30-day and 60-day mortality compared with those with no such documentation. After adjustment, the survival advantage decreased over time and was not apparent after 1 year.
Inpatient smoking cessation counseling has been demonstrated to improve cessation rates, especially when linked to an acute event such as an acute myocardial
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Life Years Gained From Smoking-Cessation Counseling After Myocardial Infarction
2017, American Journal of Preventive MedicineCitation Excerpt :Despite the robust support for SCC, most evidence for SCC after AMI comes from studies reporting higher quit rates in counseled versus non-counseled smokers6–10 and other studies finding lower short- and long-term mortality in quitters than in persistent smokers.10–14 Few studies have directly assessed the role of SCC on mortality after AMI, and only one has evaluated long-term mortality.15–18 These studies have reported lower short-term mortality for counseled versus non-counseled smokers; however, the persistence of this survival benefit over the long term is unknown.
Clinician advice to quit smoking among seniors
2015, Preventive MedicineCitation Excerpt :More research on the national prevalence of provider cessation advice is needed. Past research has used convenience samples of smokers already enrolled in smoking cessation trials (Ossip-Klein et al., 2000), or has focused on older smokers with concurrent medical conditions or hospitalizations (Brown et al., 2004; Houston et al., 2005) or clinical trials testing smoking cessation interventions outside of physician offices (Hall et al., 2009). In this study we examine the prevalence of smoking and predictors of clinician smoking cessation advice in a nationally representative sample of US adults age 65 and older.
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